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Predicting Postoperative Physiologic Decline After Surgery

Jay G Berry1,2, Connor Johnson3, Charis Crofton4

  • 1Division of General Pediatrics, Complex Care Service and jay.berry@childrens.harvard.edu.

Pediatrics
|March 3, 2019
PubMed

Insights

Predicting postoperative recovery in children is difficult. Children with complex chronic conditions (CCCs) and many medications face higher risks of postoperative physiologic decline (PoPD).

Area of Science:

  • Pediatric Surgery
  • Critical Care Medicine
  • Clinical Outcomes Research

Background:

  • Accurate prediction of postoperative recovery in pediatric surgical patients remains a significant clinical challenge.
  • Understanding factors influencing postoperative physiologic decline (PoPD) is crucial for optimizing patient care.
  • The interplay between complex chronic conditions (CCCs), medication burden, and active health issues in predicting PoPD requires further investigation.

Purpose of the Study:

  • To assess the influence of complex chronic conditions (CCCs) and chronic medication use on the likelihood of postoperative physiologic decline (PoPD) in pediatric surgical patients.
  • To investigate the interaction between CCCs, medication load, and active health problems in predicting PoPD.
  • To identify pediatric surgical patients at highest and lowest risk for PoPD.

Main Methods:

  • A prospective study involving 3295 pediatric patients undergoing elective surgery at a children's hospital.
  • Preoperative clinical evaluations documented active health problems, CCCs, and medication use.
  • Postoperative physiologic decline (PoPD) was monitored by nurses, and odds were analyzed using multivariable logistic regression and classification and regression tree analysis.

Main Results:

  • Over a quarter of pediatric patients (26.8%) experienced PoPD after surgery.
  • Factors associated with increased PoPD odds included active health problems (OR 1.2), polypharmacy (≥11 medications, OR 1.4), and multimorbidity (≥3 CCCs, OR 2.2).
  • Children with a CCC and ≥11 home medications had the highest PoPD rate (57.2%), while those without active health problems had the lowest (8.6%).

Conclusions:

  • More than 25% of pediatric patients undergoing elective surgery experienced PoPD.
  • Preoperative identification of active health problems, polypharmacy, and multimorbidity effectively distinguishes between low and high PoPD risk groups.
  • These findings highlight the importance of comprehensive preoperative assessment to stratify risk and guide perioperative management in pediatric surgery.
Abstract

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